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Научно-практическая ревматология

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Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013): место метотрексата

https://doi.org/10.14412/1995-4484-2014-8-26

Аннотация

В нашей предыдущей публикации представлена общая характеристика основных положений новых рекомендаций EULAR (2013) и обсуждены некоторые нерешенные и дискуссионные проблемы фармакотерапии
РА, требующие дальнейших исследований. Целью данной публикации является обзор современных данных, касающихся применения метотрексата (МТ), поскольку согласно рекомендациям EULAR именно «МТ следует рассматривать как основной компонент стратегии “первой линии” лечения активного РА». В контексте рекомендаций EULAR особое внимание уделено обсуждению применения МТ при раннем воспалительном (недифференцированном) артрите (НДА) и раннем РА, эффективность монотерапии МТ и комбинированной терапии, включающей, наряду с МТ, стандартные базисные противовоспалительные (БПВП) и генно-инженерные биологические (ГИБП) препараты, роль МТ в индукции и поддержании ремиссии, в том числе ремиссии без терапии ГИБП. Сделаны выводы о необходимости применения МТ у всех пациентов с ранним РА и, вероятно, у пациентов с НДА при высоком риске трансформации болезни в РА. Раннее назначение подкожной формы МТ позволяет повысить эффективность терапии РА и должно стать обязательным компонентом «интенсивной» стратегии лечения РА, независимо от применения глюкокортикоидов, других
стандартных БПВП и ГИБП. У пациентов с высокой активностью болезни, которым показано назначение высокой дозы МТ или различные схемы комбинированной терапии, целесообразно сразу начинать лечение не с таблетированной, а с инъекционной формы МТ.

Об авторах

Евгений Львович Насонов
ФГБУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» РАМН, Москва, Россия
Россия


Дмитрий Евгеньевич Каратеев
ФГБУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» РАМН, Москва, Россия
Россия


Наталья Владимировна Чичасова
ФГБУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой» РАМН, Москва, Россия
Россия


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Насонов Е.Л., Каратеев Д.Е., Чичасова Н.В. Новые рекомендации по лечению ревматоидного артрита (EULAR, 2013): место метотрексата. Научно-практическая ревматология. 2014;52(1):8-26. https://doi.org/10.14412/1995-4484-2014-8-26

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Nasonov E.L., Karateev D.E., Chichasova N.V. NEW RECOMMENDATIONS FOR THE MANAGEMENT OF RHEUMATOID ARTHRITIS (EULAR, 2013): THE ROLE OF METHOTREXATE. Rheumatology Science and Practice. 2014;52(1):8-26. (In Russ.) https://doi.org/10.14412/1995-4484-2014-8-26

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